Death by Intensive Care

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Geriatrician, Dennis McCullough wrote an excellent book titled:

My Mother, Your Mother: Embracing Slow Medicine

Keep in mind that although he writes about our elderly parents (those over age eighty), the principles he puts forward apply equally to a spouse or partner, sibling, or good friend.  If you are invested in a loved one’s well-being, please consider reading this book.  Bear with me as I provide a lengthy quote that characterizes this physician’s concerns:

Families must come to appreciate that “medicalized” care is very different in nature and cost from the personal health support and hands-on caring so essential for your parent.  In reality, our American medical system is best at managing acute crises and supplying excellent specialized elective procedures – joint replacements, organ transplants, eye improvements, cosmetic changes – all modern technological wonders.

As for the more ordinary and common management and support of elders and families dealing with chronic problems of aging and slow-moving diseases, our medical care system has not done so well.  Some elderly patients are fruitlessly subjected to what some critics now call “death by intensive care  …  “

Now let’s put ourselves into the shoes of a vulnerable adult sitting in an examination room waiting for the almighty doctor to walk through the door.  Answer this question for me: When was the last time you personally felt rushed during a doctor’s visit for yourself?  (Mine occurred last week – but I digress.)  Many of us think faster than the vulnerable adult, are able to keep track of what the doctor is saying, and have sufficient cognitive awareness to discern the doctor’s recommendations or treatment options.  Dr. McCullough wonders how an elderly person could possibly be treated effectively during a fifteen-minute office appointment by a doctor who peers into a computer screen, barely acknowledging the presence of the patient.  How can that physician possibly treat the complexities of an elder’s needs if he/she is not fully engaged in examining the patient?  Most often, the elder patient will not volunteer information that is not in direct response to a doctor’s insightful inquiries.  They are of a generation that does not question a medical professional – “after all, they have the medical degree, not me.”  The elderly patient may exit the exam room having not even discussed his or her medical concerns – simply because the doctor didn’t give her an opportunity to do so.

Dr. McCullough emphasizes how important it is that each vulnerable patient have a “Circle of Concern” – a group of people that provides steady support and insight into the patient’s needs.  That group may consist of immediate family members, friends, neighbors – anyone dedicated to providing an “active, extended advocacy partnership” that will not only attend to the patient’s technical needs, but also the emotional and human needs that are perhaps in need of greater attention.

My article, Caregiving: The Ultimate Team Sport, promotes a similar type of caring, using the analogy of a team’s various members, and their collective roles on the team.  Each person has a skill that supports the other team members’ skills.  The Circle of Concern serves this same purpose.

Perhaps we should all consider how we would like to be treated by others if/when we become dependent upon their contributions to our quality of life.  Dr. McCullough offers this snippet of Tibetan wisdom:  Make haste slowly.

Not all decisions are emergent ones.  Isn’t a person’s quality of life worth stepping back so that appropriate, “guided” decisions can be made?  Rushed judgment should not take the place of carefully considered care.  As Dr. McCullough states, “Time to begin to ask for more time.  Short of a crisis, don’t be rushed.”

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